Empagliflozin belongs to a class of sodium-glucose cotransporter-2 inhibitors, a medication approved by the US Food and Drug Administration in 2014 for the treatment of type 2 diabetes mellitus. https://www.selleckchem.com/products/ms-275.html Well-known side effects of this medication include symptomatic hypotension, hypoglycemia, and urinary tract infections among others. We present a case of severe epigastric abdominal pain consistent with acute pancreatitis in the setting of empagliflozin use, suggesting a possible drug-induced acute pancreatitis.Propofol is a widely used sedative for gastrointestinal endoscopic procedures. Drug-induced pancreatitis is a relatively rare disease possibly because of poor recognition. Propofol-induced pancreatitis is an extremely rare phenomenon. We present a 22-year-old healthy man who underwent esophagogastroduodenoscopy with propofol as a sedative. Soon after, he developed acute upper gastrointestinal symptoms and was diagnosed with pancreatitis. His prolonged hospital course was complicated with necrotizing pancreatitis, acute respiratory distress syndrome, septic shock, and other end-organ damages. We hope to increase awareness of a life-threatening adverse event of a commonly used anesthetic such as propofol.Cholestatic hepatitis is a rare presentation of thyrotoxicosis potentially confused as an adverse effect of antithyroid therapy. We report a 37-year-old man with cholestatic hepatitis as an initial presentation of Graves' disease. Diagnostic evaluation demonstrated (i) elevated transaminases and alkaline phosphatase (R-factor value 2.6), and marked cholestasis (total bilirubin 17.3 mg/dL, direct bilirubin 9.4 mg/dL); (ii) negative hepatitis, viral, and autoimmune serologies; (iii) normal magnetic resonance cholangiopancreatography; (iv) liver biopsy with marked cholestasis and no fibrosis; (v) thyroid-stimulating hormone less then 0.01, fT4 (free thyroxine) 1.5, fT4 (free triiodothyronine) 4.3 and positive thyroid-stimulating immunoglobulins. Radioiodine uptake scan confirmed Graves' disease. Clinical resolution was achieved with propranolol, prednisone, methimazole, and thyroidectomy.Biceps tendon pathology is commonly associated with rotator cuff tears. A multitude of different biceps tenodesis techniques have been studied, with limited clinical data on arthroscopic biceps tenodesis techniques incorporated into rotator cuff repairs.
To evaluate the outcomes of an arthroscopic biceps tenodesis incorporated into a supraspinatus tendon repair.
Case series; Level of evidence, 4.
Patients undergoing surgical treatment of supraspinatus tendon tears with concomitant biceps tendon pathology were prospectively enrolled from 2014 to 2015. A total of 32 patients underwent combined biceps tenodesis and rotator cuff repair; of these, 19 patients were evaluated for a mean of 2.0 years. The primary outcome measures were the American Shoulder and Elbow Surgeons Standardized Shoulder Assessment Form (ASES; patient self-report and physician assessment sections), visual analog scale (VAS) pain score, responses to specific biceps-related assessments, and biceps specific physical exam findings.
Patient-reported ASES scores improved from 45.9 preoperatively to 91.6 at the 2-year follow-up (&lt; .001). Pain VAS scores improved from 5.2 preoperatively to 0.7 at the 2-year follow-up (&lt; .001). Preoperatively, 18 patients had a positive Speed test; all were negative at 5 months postoperatively, and 21 patients had bicipital groove tenderness preoperatively, which resolved in all 21 patients at 5 months postoperatively. At the 2-year follow-up, 2 patients had cramping arm pain and 4 patients noticed a change in arm contour. There were no reoperations. No complications occurred in the study group.
Arthroscopic biceps tenodesis incorporated into a supraspinatus tendon repair was a safe and reliable option for biceps pathology with a concomitant rotator cuff tear.
Arthroscopic biceps tenodesis incorporated into a supraspinatus tendon repair was a safe and reliable option for biceps pathology with a concomitant rotator cuff tear.There is currently no optimal method for cartilage restoration in large, full-thickness cartilage defects in older patients.
To determine whether implantation of a composite of allogeneic umbilical cord blood-derived mesenchymal stem cells and 4% hyaluronate (UCB-MSC-HA) will result in reliable cartilage restoration in patients with large, full-thickness cartilage defects and whether any clinical improvements can be maintained up to 5 years postoperatively.
Randomized controlled trial; Level of evidence, 1.
A randomized controlled phase 3 clinical trial was conducted for 48 weeks, and the participants then underwent extended 5-year observational follow-up. Enrolled were patients with large, full-thickness cartilage defects (International Cartilage Repair Society [ICRS] grade 4) in a single compartment of the knee joint, as confirmed by arthroscopy. The defect was treated either with UCB-MSC-HA implantation through mini-arthrotomy or with microfracture. The primary outcome was proportion of participantups at 48 weeks, however the clinical results were significantly better in the UCB-MSC-HA group at 3- to 5-year follow-up (&lt; .05). There were no differences between the groups in adverse events.
In older patients with symptomatic, large, full-thickness cartilage defects with or without osteoarthritis, UCB-MSC-HA implantation resulted in improved cartilage grade at second-look arthroscopy and provided more improvement in pain and function up to 5 years compared with microfracture.
NCT01041001, NCT01626677 (ClinicalTrials.gov identifier).
NCT01041001, NCT01626677 (ClinicalTrials.gov identifier).The prevalence of patellofemoral joint (PFJ) osteoarthritis ranges from 8% to 47% at 7 to 10 years after anterior cruciate ligament reconstruction (ACLR) using bone-patellar tendon-bone (BTB) autograft. In performing BTB ACLR, some hypothesize that either trauma caused by harvest of the BTB autograft or altered biomechanics contributes to PFJ posttraumatic osteoarthritis.
To determine whether knees with ACLR using a BTB autograft show early signs of posttraumatic osteoarthritis as compared with the contralateral uninjured knee 2 years after ACLR. We hypothesized that a BTB autograft will not increase the prevalence of PFJ osteoarthritis.
Cohort study; Level of evidence, 3.
Bilateral knee 3-T magnetic resonance imaging (MRI) scans were collected in 57 patients (mean age, 20.3 years; 28 men) from a single site at a minimum of 2 years after ACLR. Structural MRI assessment of the knees was performed using the MRI Osteoarthritis Knee Score semiquantitative scoring system by a board-certified musculoskeletal radiologist.